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cesses then in operation, removed, as it was, from the greatmotor centres. One of the most interesting features in thecase was the stationary character of the symptoms, and theabsence of any indications of progressive organic changeup to within a few days of death; and it may be well todraw attention to the complete absence of paralysis,with the exception of the partial ptosis, up to the time atwhich coma set in. The aphasia was due, not to any diffi-culty in the mechanical act of articulation, or in the origi-nation of ideas, but it resulted from an inability to seizeupon or arrange the words corresponding with the thoughtshe evidently wished to express. It will be noted that theleft middle cerebral artery, though involved in the thickeneddura mater, was pervious. There was no apparent lesion ofBroca’s convolutions, or of the corpus striatum, or of any ofthe great nuclei in the neighbourhood. The alteration inthe consistence of the pons and medulla, which was con-fined to the left side, was probably acute, and unconnectedwith any vascular lesion or obstruction. It is probablethat the disease was specific, that it commenced in the duramater, and extended to the subjacent bone, producingcaries. The lesion was situated in close proximity to thefissure of Sylvius, and the part of the brain about whichso much has been written with regard to the faculty ofspeech, but although it was sufficient to produce a temporaryaphasia, it had not extended into the cerebral substance orreached the motor centres, and this may account for theabsence of paralysis. The third nerve was involved eitherin the outer wall of the cavernous sinus, or, more probably,in the sphenoidal fissure, as the branch which supplies thelevator palpebrae was principally affected. The ophthalmo-scopic appearances were very interesting ; possibly pressureon the third nerve produced alteration in the nutrition ofthe eye through the lenticular ganglion, and thus causedan appearance as of a cloudy vitreous. The adherent peri-cardium was not diagnosed during life; the only note madewas to the effect that the second sound of the heart wasDrolonsed.

EDINBURGH ROYAL INFIRMARY.SURGICAL CASES.

(Under the care of Mr. JOSEPH BELL.)For the notes of the following interesting cases we are

indebted to Mr. Holland J. Cotton, house-surgeon.Case of Compound Comminuted’ Fracture of Lower Jar ;

threatened Spinal Meningitis; Recovery.-Harriet L-, agedseventeen, a servant-erirl of weak mind, was admitted onthe 28th November, 1874, suffering from a compound com-minuted fracture of the lower jaw on the left side, a laceratedwound over the patella, and a bruise over the lumbar regionof the spine. The patient, in a state of temporary frenzy,had thrown herself from a window four storeys high, in oneof the best squares of the city, but her fall was happily brokenby coming in contact with tha sloping roof of an out-house.Mr. Bell, who was sent for at once, found a lacerated wound,fully three inches long, over the left horizontal ramus of thejaw, which itself was shattered into several fragments andprotruding from the wound. The cavity of the mouth wasopened into, and several teeth were broken and hangingloose. Having removed all loose fragments of jaw, but withas little of the periosteum as possible, Mr. Bell brought theupper and lower fragments together by boring the bone andpassing stout silver wire through it. The bleeding waseasily stopped, although the facial artery was completelytorn across. A portion of dental nerve too, which was lyingexposed, had to be removed. The wound was then sewn up,a drainage tube being passed right through into the mouth.For the next three nights the patient was in a most

critical condition, suffering from convulsive attacks of themuscles of the face and limbs, and presenting most of thesymptoms of spinal meningitis. At the suggestion of oneof the physicians to the hospital, forty grains of the bro-mide of potassium were given five or six times in the twenty-four hours, with an occasional dose of chloral at night, in-stead of the fifteen-grain doses of bromide of potassium andchloral thrice a day which she had previously taken. Thisin a few hours had the desired effect of subduing the con-stant twitching movements and removing the sleeplessness.The patient having thus been brought fully under the in-fluence of the drug, the large doses were discontinued, and

only a moderate dose administered whenever twitching ofthe muscles or great restlessness occurred. The woundmeanwhile progressed favourably enough, being dailywashed with a weak lotion by means of the tube whichcommunicated with the mouth. There was much swellingof that side of the cheek, and there was a copious fetiddischarge. The wound over the patella healed slowly, butwas quite superficial, whilst the bruise over the spine wasfollowed by no discolouration from ecchymosis. For daysafter, convulsive movements, however, could at once bebrought on by firm pressure over one spot along the spine ; gand though the patient was eminently hysterical, yet thesemovements were evidently involuntary.The after-progress of the case was slow, the fragments of

jaw still crepitating, and occasionally causing considerablepain. A sinus remained; but at length (nearly two monthsafter the accident) the two pieces of silver wire, which hadheld the fragments together, along with several spicula ofdead bone, were expelled from the external orifice. By thistime the jaw was consolidating rapidly, much new bonebeing thrown out, and little inconvenience being experiencedtherefrom. In another month the sinus had almost com-

pletely healed, and the patient ceased to attend the hos-pital, her jaw being firmly united, and her face wonderfullylittle distorted.

Case of Acute Necrosis of the Ulna; Removal of the entire’Shaft; rapid Reproduction; Recovery.-Marion M——, agedeight, was admitted on the 31st of December, 1874, suffer-ing from acute necrosis of the right ulna, and an incipientlumbar abscess. On the eighth day of the same month shehad complained of shivering and headache, then of pain inher right forearm; and on the third day a red line was.noticed stretching up the inner side of the limb, withswelling as far as the elbow. A doctor was called in, andhe, after a week’s attendance, incised the arm in two placesand evacuated some pus; but finding that the patient wasdaily getting worse, and that an abscess was threatening toform over the right dorsum ilii, he sent her to the infirmary.On admission the child was very weak, and looked exces-

sively ill, complaining of much pain in the arm and back.On Jan. 2nd Mr. Bell removed the whole shaft of the ulna,which was necrosed, leaving the periosteum entire as far aspossible, and at the same time he evacuated some serumfrom the lumbar swelling by means of a trocar. The patientimproved rapidly after the operation, regaining her appe-tite, and looking quite a different child. The lumbar swell-ing disappeared, whilst in the arm much new bone wasthrown out, and the wound granulated healthily.On Jan. 30th she became an out-patient, and came occa-

sionally to have her arm dressed. The whole shaft of thaulna had been reproduced, and the movements of pronationand supination were practised daily. For some weeks aftera sinus remained, through which occasionally spicula of

! bone escaped, but this finally healed up; and the patientwas dismissed with an arm capable of perfect movements,the ulna being slightly thicker than that of the other arm.

’ Of the lumbar swelling nothing remained but a thickeningof the crest of the dorsum ilii.

Reviews and Notices of Books.Traite de Thérapeutique Médicale, ou Guide pour l’Applicatio2 .

des Principauae 1J[odes de Médication à l’Indication Théra-

peutique. Par le Dr. A. FERRAND, Medecin des H6pitaux:de Paris. Paris : Bail1ière.

THE relations of therapeutics are twofold. Its provinceis to determine the application of remedial agents to diseasedaction. On the one hand, therefore, it has to consider the

disease, and on the other the remedy. Its study may beapproached from either side. It is commonly taught inconjunction with materia medica. This method has a

certain convenience, but it is founded on a connexion whichis not, perhaps, the most important of its relations. A sepa-rate monograph on the action and use of each drug necessi-tates a minute subdivision of the subject of therapeutics,and a disjointed and most unsystematic treatment of each

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part. It is upon this plan, however, that most treatises various derangements of these systems, to what extent theyhave been written, as, for instance, those of Pereira, Garrod, will excite or calm their elementary functions, and we canGubler, Stille’, &c.; but the method has never satisfied the obtain, to a considerable extent, by the administration ofearnest therapeutist. The fragmentary and disjointed pre- this or that agent the effect we desire.sentation of the subject, like a reflection from broken water, The practical application of these principles to various

conveys a very imperfect idea of its scientific form; hence diseases involves of necessity the discussion at some lengthmany attempts have been made to unite the scattered of many details in their pathology and symptoms. Thiselements. Groups of remedies have been considered constitutes indeed the main bulk of the volume before us.

together, a common description of their action being given, Various classes of maladies are successively considered-and thus by describing together cognate subjects, and first, nervous affections, cerebral, spinal, and sympathetic;avoiding unnecessary repetition, better system has been next, vascular affections; and, subsequently, troubles ofsecured. But it is evident that any discussion of thera- secretion, of nutrition, alterations of the blood, inflamma-peutics from the side of drugs must leave one half, and that tions, fevers, infectious diseases, constitutional affections,the more important half, of the subject very imperfectly toxic states, and parasitic diseases. The several indicationstreated. What to administer under any given circum- referring to each of these "elementary troubles" aresuc-stances must always depend as much, or more, on the cessively studied: first, the signs which characterise each,occasion as on the substance to be given. In each disease, the variations in intensity which it may offer, the conse-in every variety of each, the needful remedial agent or the quences it may entail, its essential pathology, the variousmode of its administration may vary, and it is in the due remedial agents which may influence it, and the morerecognition of the significance of each indication for treat- immediate indication in each case for their employ-ment that the more refined part of the science and art of ment.

therapeutics consists. It is this part which admits, we are As an example of the system, the third part may be taken,told, of the most systematic treatment-which can be raised the subject of which is the indication for treatment drawnwith most completeness to something like scientific dignity. from disturbances of the vascular system. The first chapterThis part of the subject is considered, it is true, in the is devoted to the "indication furnished by vascular con-systematic treatises on disease, but it is there subordinated gestion." The elementary type of vascular congestion is firstto diagnosis and pathological anatomy, and is not discussed described-i. e., the general characters of the morbid process.with that width of generalisation which its importance and Its "pathology " is then discussed, the nervous and othercapabilities deserve. To effect this is the object of Dr. agents concerned being briefly spoken of. The secondFerrand’s treatise. section is devoted- to the "therapeutical indication," whichA little consideration will render it clear that the indica- is, in this case, the diminution of the afflux of blood in the

tions for treatment which different diseases afford are of so distended vascular system; and the means by which thisvaried a character that any attempt at their generalisation object may be attained are successively discussed-(l)must produce a system of considerable complexity. This is hygienic methods, as food, posture, cold; (2) moderatingunquestionably the case in that which is unfolded in the remedies which may lessen the force of the blood and lower

work before us. The various "indications "for the treat- the temperature; (3) "contra-stimulant remedies," which,ment of disease may be grouped in three classes-those acting through the nervous system, seem to cause ansemiaafforded by the nature of the malady, by its form, and by of organs; (4) stimulant treatment, when the congestionits local manifestation. These are termed respectively the is associated with a sluggish circulation behind the affected"nosological," "physiological," and " anatomical" ele- part; (5) astringent treatment;, local and general; (6) directments, all of which are presented by each case of disease evacuant treatment, as by local depletion; (7) indirectsubmitted to treatment. As therapeutical indications evacuant treatment, as by purgation. An article followsthese elements differ in value. The nosological element, on the "mediate indications" for treatment, furnished bythe essential nature of the disease, is its effective, or rather the pathological state in which the congestion arose, asits realised, cause. The physiological element is due to the specific, diathetic, or degenerative disease. A final articlereaction of the system against the malady, and determines on "application" contains sections on the various formsthe form of the disease. The local seat, secondary in point and seats of congestion, and their appropriate treatment:of time, which constitutes the third element, is of little general congestion, and congestion of brain, spine, lungs,value as an indication for treatment, since it is only a stomach and intestines, rectum, liver, spleen, kidneys,secondary fact in the constitution of the malady, and is of uterus, on congestions in fever, and on those secondary toless significance as to the remedial agent to be chosen than diseases of the heart; and under each head the appropriateas to the place and mode in which it should be used. The treatment is described. The remedies given as appropriate"nosological" element is intimately united to the idea of to renal congestion are to furnish the organs with thethe specificity -of disease, and furnishes an indication of elements for ready secretion, by diluent drinks and milk,greater value, as is shown by the instances in which there avoiding irritating substances, as alcohol, and giving salinesexists a, specific remedy for a definite disease. But the and diuretics with great caution, favouring secretion fromrarity of the instances in which this is the case, and skin and intestine, and employing, when necessary, revulsivethe purely empirical mode in which alone the indication measures, as sinapisms, &c. In a similar manner, and at

can be utilised, narrow the part it can play in general almost equal length, the phenomena of anaamia and hsemor-therapeutics. The "physiological" element, that which rhage are discussed in their several relations. The otherdetermines the form of the disease, is the true ground of sections are treated in a similar manner.

therapeutical indication. It is so termed because it rests on The system thus sketched is elaborated in the work at

the physiological properties of the tissues, the reaction of detailed and cumbersome length, but with a completenesswhich determines the form of the disease, but in its employ- and a patience on which the author must be congratulated.ment the effects of functional and of nutritive changes The system itself is perhaps as thorough as the presenthave to be carefully distinguished. We know the sub- state of our knowledge will permit. In working it out,stances which, in a physiological condition, accelerate or however, the Materia Medica side of therapeutics has beenretard the activity of this or that organic system ; we know necessarily altogether subordinated, so as to reduce thehow far these substances preserve that property in the practical usefulness of the book far below its value as an

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exposition of the theory of therapeutics. Some portions ofthe subject, also, closely connected in theory, are separatedhere, but this is perhaps inevitable from its wide andvaried relations.

The Surgeon’s Pocket-book: being an Essay on the best Treat- !

ment of Wounded in War. By Surgeon-Major J. H.PORTER, late 97th Regiment, Assistant-Professor ofMilitary Surgery, Army Medical School, Netley. London:Chas. Griffin and Co. 1875.

THE materials of this handbook formed the essay forwhich a prize was awarded by Her Majesty the Queen ofPrussia and Empress of Germany in the year 1874, andthey have been specially adapted for the public medicalservices.

Its conspicuous merit consists, in our opinion, in the skilldisplayed in the selection and arrangement of its informa-tion. It contains little that is absolutely new perhaps,but the information, which is of the most practical kind,has not been put together, as is too of ten the case, with littlediscrimination or judgment, but with an evidently honestintention of giving the military and naval surgeon anepitome of the latest and best views, and the most trust-worthy methods, of treatment of the wounds and injuriesincidental to warfare. To write a good book on a subjectof this kind is really a far more difficult task than is gene-rally imagined, for its author must not only have been anindustrious and critical reader, but a sagacious and goodobserver of what the requirements of the army surgeon areunder circumstances and in emergencies which try thepractical ingenuity and judgment of a man in a way thatthey are never likely to be tried in civil practice, wherethere cannot be the same demand for promptitude anddecision, where every appliance is at hand, and where theafter-treatment of an operation can be carried on leisurely,and without the dangerous risks that have to be en-countered in the field from overcrowding, insufficient food,hurried dressings, and frequent changes of locality. Theauthor has not written a manual on surgery, of course, butlimited himself to those subjects which concern the militaryand naval surgeon, including a variety of matters aboutwhich medical officers will find it very useful to have a

ready guide in field practice. Without being too diffuse,the author has not erred on the side of being too dogmatic.He has given the different views and varieties of practiceinculcated by different authorities where these are notagreed, leaving the reader to exercise, his own judgment.He has drawn on the writings of German, French, Italian,and American surgeons, as well as those of this country, forthe materials of his book, which is besides well illustrated,and altogether a very creditable and useful production.

Popular Natural Philosophy. Translated and Edited fromGanot’s 11 courts Elementaire de Physique," by G. ATKINSON.Ph.D. Second Edition. London: Longmans. 1875.-Weare glad to notice this little book, which will prove usefulto a wide circle of readers and teachers, since it representsabout the amount of knowledge required for the Matricula-tion examination of the London University. It is dividedinto eight books, treating respectively of the General Pro-perties of Matter, Hydrostatics, Gases, Acoustics, Heat,Light, Magnetism, and Electricity. It is admirably illus-trated, and throughout most clearly written. It ought tobe in the hands of the higher classes of all our public schools,and if the principal facts it contains were early demon.strated by experiment to those about to become members ofthe profession we should have a far larger number of

accurate observers, and much fewer loose theories than at

present.

GLASGOW IN 1874.

THE annual report upon the " Vital, Social, and EconomicStatistics of Glasgow for 1874" has recently been issued byMr. W. W. Watson, the City Chamberlain, and contains in-valuable materials for a careful study of the growth andsanitary condition of this important city. The populationof Glasgow, which in 1801 was but 77,385, was estimated at508,109 in the middle of 1874. Between 1811 and 1821 theincrease of population was equal to 46 per cent., whereas inthe last two decades, 1851-61 and 1861-71, it did not exceed20 and 21 per cent. respectively. The marriage-rate in 1874in Glasgow was equal to 19’7 per 1000, and correspondedwith the rate in 1873; the birth-rate was 39 4 per 1000, arate which considerably exceeded that which prevailed inany recent year, except 1872; the death-rate was also ex.

ceptionally high, and equal to 31-2 per 1000; excepting 1871,so high a death-rate has not prevailed in any year of the

, past decade. In referring to this excessive death-rate in; Glasgow last year, it may be noticed that Mr. Watson has

revived a now all but exploded false theory, when he says," We must not lose sight of the fact that a very high birth-rate, such as is exhibited above, leads of necessity to a heavydeath-rate, from the very large proportion of the infantiledeaths which occur in a dense manufacturing population."This fallacy, which was not long ago put forward by Dr.Letheby, was recently

so conclusively exposed in a paperread before the Statistical Society that it is surprisingto find one of its fellows reproduce it without any allusionto the controversy to which it gave rise. It has been provedbeyond all doubt that in all populations in which high birth-rates prevail the effect upon the death-rate of the large pro.portion of infants and young children is more than counter-balanced by the high proportion of young adults, among

. whom the rate of mortality is low, and by the small pro.portion of persons aged upwards of sixty years, who areliable to a death-rate nearly as high as are children underfive

years of age. Sanitary condition being equal, the death-

rate in Glasgow ought to be lower than in the rural portionsof Scotland, where the birth-rate falls below 30 ppr 1000.The explanation of the high rate of mortality in Glasgowin 1874 is, however, not very difficult to discover. The re-markable severity of the weather in the latter part ofNovember and throughout December caused almost uni-versally high death-rates. Glasgow suffered to an exceptionalextent, even for a large town. During October 1274 deathswere registered, while the number rose to 2101 in December.The greatest sufferers were adults and elderly people ; amongchildren and young people under twenty years of age the

deaths in December exceeded those in October by 26 per cent.,between twenty and sixty years the increase was equal to119 per cent., and among persons over sixty years to 208per cent. As regards the causes of death in 1874, we findthat bronchitis and pneumonia killed 3332 persons, against2934 in 1873, and that the fatal cases of scarlet fever showedan increase of 1072. Much has undoubtedly been done inGlasgow in recent years to improve its sanitary condition,and it would be manifestly unfair to take the result of soexceptional a year as 1874 as evidence that no real improve-ment has taken place. Mr. Watson very properly callsattention to the marked decline in the deaths from typhusin recent years. In 1864 and 1865 the fatal cases in Glasgowwere 1138 and 1117; the average annual deaths from thisdisease in the ten years ending 1874 declined to 479, andthe numbers in 1873 and 1874 were but 79 and 114 re-spectively. When we observe, however, that the annualdeatb-rate from the seven principal zymotic diseases wasequal to 74 per 1000 of the population in Glasgow in 1874,whereas it was but 3’3 in London, and averaged 4’5 ineighteen of the largest English towns, the sanitary workthat has still to be done in the largest Scotch town is buttoo painfully apparent. We shall anticipate with muchinterest the report of Dr. James B. Russell, the medicalofficer of health for Glasgow, upon the exceptional mortalityduring 1874.